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  • Question 1 - A 50 year old female was examined after complaining of weak limbs. It...

    Incorrect

    • A 50 year old female was examined after complaining of weak limbs. It was discovered she had burn marks on her fingers, diminished reflexes, and wasted and weak hands. Additionally, she has dissociated sensory loss and weak spastic legs. What is the diagnosis for this patient?

      Your Answer:

      Correct Answer: Syringomyelia

      Explanation:

      All of the symptoms experienced by this patient are consistent with Syringomyelia. The sensory features are as follows: loss of temperature and pain sensation; sensory loss in the arms, shoulders, and upper body; touch, vibration, and position senses are affected in the feet as the syrinx enlarges into the dorsal column. Motor features are as follows: muscle wasting and weakness which begins in the hand, and moves onto the forearms and shoulders; loss of tendon reflexes. Autonomic involvement, such as the bladder and bowel, can occur.

    • This question is part of the following fields:

      • Neurology
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  • Question 2 - All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are...

    Incorrect

    • All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?

      Your Answer:

      Correct Answer:

      Explanation:

      Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.

    • This question is part of the following fields:

      • Neurology
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  • Question 3 - A 51-year-old woman complains of sudden onset of severe headache and vomiting that...

    Incorrect

    • A 51-year-old woman complains of sudden onset of severe headache and vomiting that is worse when she is lying flat. Fundoscopy confirms bilateral papilledema. Which is the definitive investigation in this case?

      Your Answer:

      Correct Answer: Computed tomography scan

      Explanation:

      A head CT scan is the best step to rule out a mass lesion or bleed. Since the patient has symptoms that may suggest elevated intracranial pressure (ICP), a lumbar puncture should be consulted first with a neurologist since it is contraindicated in this case due to raised ICP and risk of coning.

    • This question is part of the following fields:

      • Neurology
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  • Question 4 - A 25 year old patient has presented with symptoms which all point to...

    Incorrect

    • A 25 year old patient has presented with symptoms which all point to the cerebellopontine angle (CPA) a tumour. These are numbness in the face, vertigo, and tinnitus. Choose the most appropriate investigation from the list of options.

      Your Answer:

      Correct Answer: MRI Brain

      Explanation:

      MRI scans are used to diagnose tumours in the cerebellopontine angle.

    • This question is part of the following fields:

      • Neurology
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  • Question 5 - A 74 year old man presents with a history of falls and enuresis....

    Incorrect

    • A 74 year old man presents with a history of falls and enuresis. Recently his behaviour has been bizarre but the falling has persisted for the last 12 months. Upon examination he's found to be disorientated for time and place. His gait is clumsy and broad-based. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Normal pressure hydrocephalus

      Explanation:

      The patient has a history of:
      1 – Balance and gait disturbance – falls and broad based clumsy gait
      2 – Dementia – strange behaviour and disorientation to time and place
      3 – Urinary incontinence – episodes of enuresis.
      All of the symptoms constitute the classic triad of normal pressure hydrocephalus.

    • This question is part of the following fields:

      • Neurology
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  • Question 6 - A 75-year-old woman experienced right sided weakness shortly after she woke up. However,...

    Incorrect

    • A 75-year-old woman experienced right sided weakness shortly after she woke up. However, the weakness resolved in 30 minutes and left no disability. Her CT and ECG appear normal. What extra actions should be taken if she is already on Aspirin, Simvastatin, Amlodipine and Bendroflumethiazide?

      Your Answer:

      Correct Answer: Start Aspirin 300 mg for 2 weeks

      Explanation:

      The patient has most probably experienced a transient ischemic attack which should be initially managed with aspirin 300 mg for two weeks.

    • This question is part of the following fields:

      • Neurology
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  • Question 7 - A 65 year old female with a history of memory loss, presents with...

    Incorrect

    • A 65 year old female with a history of memory loss, presents with progressive decline of her cognitive functions. She had a MI 6 years ago. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Vascular dementia

      Explanation:

      The patient has a history of MI and thus ischemic heart disease. This together with her age and progressive decline in cognitive functions and memory suggest vascular dementia.
      Pick’s dementia presents with personality and behavioural changes.
      Lewy body dementia is associated with frequent syncopal episodes, while Huntington’s disease presents with gait abnormalities.
      Alzheimer’s dementia usually starts before the age of 65 and an ischemic heart disease history is not necessary.

    • This question is part of the following fields:

      • Neurology
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  • Question 8 - A 55-year-old male visited his diabetic clinic with a complaint of inability to...

    Incorrect

    • A 55-year-old male visited his diabetic clinic with a complaint of inability to walk properly due to weakness of his lower limbs. On examination, dorsiflexion was found to be weak bilaterally and there was diminished sensation on the dorsum of his feet as well as on the lower lateral portions of his legs. Which of the following could have led to this condition?

      Your Answer:

      Correct Answer: Compression of the common peroneal nerve

      Explanation:

      The branches of the common peroneal nerve innervate the skin of the dorsum of the foot as well as the muscles which help to carry out dorsiflexion of the foot. Compression of the common peroneal nerve cause foot drop as well as the loss in sensation of the skin on the dorsum of the foot.

    • This question is part of the following fields:

      • Neurology
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  • Question 9 - A 45-year-old male, came to the OPD with a complaint of severe headache...

    Incorrect

    • A 45-year-old male, came to the OPD with a complaint of severe headache on the right side with right-sided jaw pain and additional blurred vision in the right eye. The headache was throbbing in character. What is the single most appropriate investigation?

      Your Answer:

      Correct Answer: ESR

      Explanation:

      The age of the patient, one sided headache and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - A 51-year-old man speaks fast and does not take enough breaths before speaking...

    Incorrect

    • A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?

      Your Answer:

      Correct Answer: Pressure of speech

      Explanation:

      A pressured speech is too fast for the listener to understand and is very difficult to interrupt.

    • This question is part of the following fields:

      • Neurology
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  • Question 11 - A 19-year-old patient in casualty only opens her eyes upon painful stimuli, extends...

    Incorrect

    • A 19-year-old patient in casualty only opens her eyes upon painful stimuli, extends her limbs, and occasionally says inappropriate words. What is her Glasgow coma score?

      Your Answer:

      Correct Answer: 7

      Explanation:

      The Glasgow Coma Scale provides a score for assessment of impaired consciousness in response to specific stimuli considering the eye opening, verbal response and motor response. The score runs from 3 to 15, a coma being defined as a GCS of 8 or less. According to this patient’s responses and the respective points for each response, the score is 7 and the patient is in a coma.

    • This question is part of the following fields:

      • Neurology
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  • Question 12 - A 33 year old male was brought in with complaints of an unsteady...

    Incorrect

    • A 33 year old male was brought in with complaints of an unsteady gait. According to the patient, he suffered a severe headache in the morning, with associated vomiting. Slowly his condition deteriorated until he was unable to walk. On exam, he had nystagmus and there was past pointing of the right arm. He speech was slurred, his uvula was deviated towards the right and there was decreased pin prick sensation on the right half of the body. The most likely site of the lesion in this patient would be?

      Your Answer:

      Correct Answer: Left lateral medulla

      Explanation:

      Loss of sensations in left (ipsilateral) side of the face and contralateral (right) side of the body indicates a defect in left lateral medulla. Further cerebellar signs lead to the diagnosis of Lateral Medullary Syndrome.

    • This question is part of the following fields:

      • Neurology
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  • Question 13 - A 24 year old male was involved in a traffic collision. X-rays indicated...

    Incorrect

    • A 24 year old male was involved in a traffic collision. X-rays indicated that the neck of the humerus had suffered a fracture. Choose the single most associated nerve injury from the list of options.

      Your Answer:

      Correct Answer: Axillary nerve

      Explanation:

      Fractures in the neck of the humerus are well documented to cause damage to the auxiliary nerve.

    • This question is part of the following fields:

      • Neurology
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  • Question 14 - A 34 year male is brought to the emergency by the paramedics...

    Incorrect

    • A 34 year male is brought to the emergency by the paramedics who found him unconscious after being hit by a car. However, he regained consciousness and began talking. While waiting for the doctor's review, he suddenly becomes comatose and the condition deteriorates. What will be the most likely diagnosis?

      Your Answer:

      Correct Answer: Extradural haemorrhage

      Explanation:

      Extradural haemorrhage occurs as a result of head trauma and subsequent acute haemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.

    • This question is part of the following fields:

      • Neurology
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  • Question 15 - In last 5 days, an old man has complained of severe left sided...

    Incorrect

    • In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Migraine

      Explanation:

      Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.

    • This question is part of the following fields:

      • Neurology
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  • Question 16 - A 51 year old male patient presents with acute back pain, which worsens...

    Incorrect

    • A 51 year old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?

      Your Answer:

      Correct Answer: Magnetic resonance imaging (MRI)

      Explanation:

      A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 17 - A 60-year-old male presented in OPD with a complaint of inability to walk...

    Incorrect

    • A 60-year-old male presented in OPD with a complaint of inability to walk properly because of his left foot. History reveals he has undergone left knee surgery to for severe arthritis. On examination, dorsiflexion of his left foot was found to be compromised, and sensation over the dorsum of his left foot was impaired. Which of the following conditions is this man most likely suffering from?

      Your Answer:

      Correct Answer: Compression of common peroneal nerve

      Explanation:

      The branches of the common peroneal nerve innervate the skin of the dorsum of the foot as well as the muscles which help to carry out dorsiflexion of the foot. Compression of the common peroneal nerve cause foot drop as well as the loss in sensation of the skin on the dorsum of the foot.

    • This question is part of the following fields:

      • Neurology
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  • Question 18 - A 7-year-old boy was brought to the ED in an unconscious and apnoeic...

    Incorrect

    • A 7-year-old boy was brought to the ED in an unconscious and apnoeic state. What is your immediate management of this case?

      Your Answer:

      Correct Answer: Secure airway

      Explanation:

      ABC : Airway, breathing, circulation is the order of assessment in any patient that is unconscious and apnoeic.

    • This question is part of the following fields:

      • Neurology
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  • Question 19 - A 42 year old male has suffered a stroke - he is unable...

    Incorrect

    • A 42 year old male has suffered a stroke - he is unable to walk in a straight line and has slurred speech. From the list of options, choose the most appropriate investigation to proceed with.

      Your Answer:

      Correct Answer: CT scan brain

      Explanation:

      CT scans are used to produce images of the brain. It can be used to detect a stroke from a blood clot or bleeding within the brain.

    • This question is part of the following fields:

      • Neurology
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  • Question 20 - A 32 year old female has had an episode of a severe occipital...

    Incorrect

    • A 32 year old female has had an episode of a severe occipital headache. This is accompanied by vomiting and unconsciousness. She has been taken to the emergency department, where she is conscious and completely alert. Her pulse is normal and no abnormal neurological signs are found. From the list of options, choose the next step in her treatment.

      Your Answer:

      Correct Answer: CT brain

      Explanation:

      Severe headaches and LOC can be caused by basilar migraines (but here the patient has no neurological deficit and becomes completely alert when recovering from unconscious periods). In order to diagnose basilar migraines, there needs to be a history of at least two other migraine attacks with an aura. The diagnostic criteria of a basilar migraine are not fulfilled and so the patient must not be discharged without a CT scan.

    • This question is part of the following fields:

      • Neurology
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  • Question 21 - A 44 year old alcoholic man was operated on for a strangulated abdominal...

    Incorrect

    • A 44 year old alcoholic man was operated on for a strangulated abdominal hernia, however a few days after the operation he became agitated. According to the patient, he used to see snakes curling over his body. O/E he was agitated, tachycardiac and confused. The most likely diagnosis would be?

      Your Answer:

      Correct Answer: Delirium tremens

      Explanation:

      Delirium tremens occurs due to alcohol withdrawal and presents clinically with hallucinations, agitations, confusion and hyperthermia. Wernicke’s encephalopathy is characterised by encephalopathy, oculomotor dysfunction and ataxic gait. In Korsakoff’s syndrome, there is marked short term memory loss, however the long term memory is preserved & the sensorium is also intact.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 61-year-old man presented with a TIA and loss of consciousness for 30...

    Incorrect

    • A 61-year-old man presented with a TIA and loss of consciousness for 30 min. His CT brain scan is normal and his ECG shows atrial fibrillation. Which risk assessment score is best used in this case?

      Your Answer:

      Correct Answer: CHADS2

      Explanation:

      CHADS2 score provides a comprehensive prediction of thromboembolic events in avalvular AF patients:
      C Congestive heart failure – 1
      H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) – 1
      A Age ≥75 years – 1
      D Diabetes mellitus – 1
      S2 Prior Stroke or TIA or Thromboembolism – 2

    • This question is part of the following fields:

      • Neurology
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  • Question 23 - The drug of choice for delirium tremens will be? ...

    Incorrect

    • The drug of choice for delirium tremens will be?

      Your Answer:

      Correct Answer: IV Chlordiazepoxide

      Explanation:

      The drugs of choice for delirium tremens are benzodiazepines such as chlordiazepoxide, diazepam or lorazepam. Chlordiazepoxide is a long acting drug and is the preferred drug, before the other benzodiazepines. Barbiturates are the 2nd drugs of choice.

    • This question is part of the following fields:

      • Neurology
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  • Question 24 - A 65-year-old female presented with episodes of unilateral blindness, which spontaneously resolved. Her...

    Incorrect

    • A 65-year-old female presented with episodes of unilateral blindness, which spontaneously resolved. Her cardiovascular examination was normal. What is the single most appropriate investigation that can be performed to arrive at a diagnosis?

      Your Answer:

      Correct Answer:

      Explanation:

      Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour, which is the screening test of choice to evaluate for carotid stenosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 25 - A 50-year-old known patient with chronic liver cell disease was admitted complaining of...

    Incorrect

    • A 50-year-old known patient with chronic liver cell disease was admitted complaining of unsteadiness and double vision following an episode of heavy alcohol consumption. On examination, he was confused. there was nystagmus and ataxia. What is the most possible cause for this presentation?

      Your Answer:

      Correct Answer: Wernicke’s encephalopathy

      Explanation:

      Wernicke’s encephalopathy is a neurological disorder induced by thiamine deficiency and presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. As alcohol affects thiamine uptake and utilization, thiamine deficiency is usually associated with chronic alcoholism.

    • This question is part of the following fields:

      • Neurology
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  • Question 26 - An 18-year-old female patient presents with a history of headache and photophobia. You...

    Incorrect

    • An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?

      Your Answer:

      Correct Answer: A family history of polycystic renal disease

      Explanation:

      Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.

    • This question is part of the following fields:

      • Neurology
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  • Question 27 - A 61 year old woman with a history of fluent dysphasia is brought...

    Incorrect

    • A 61 year old woman with a history of fluent dysphasia is brought by her husband because she's no longer able to understand instructions. Which is the most probable site of arterial occlusion?

      Your Answer:

      Correct Answer: Inferior division of middle cerebral artery (dominant hemisphere)

      Explanation:

      The condition described is called Wernicke’s aphasia and is the result of occlusion of the inferior division of the middle cerebral artery. This type of aphasia is classified as fluent aphasia in which understanding is impaired.

    • This question is part of the following fields:

      • Neurology
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  • Question 28 - A 30 year old male with a scaphoid fracture came to the clinic...

    Incorrect

    • A 30 year old male with a scaphoid fracture came to the clinic after 2 weeks of applying the scaphoid cast. After removing the cast he had difficulty moving his thumb, index and middle fingers. Which of the following is the most appropriate management for this presentation?

      Your Answer:

      Correct Answer: Release of flexor retinaculum

      Explanation:

      This patient has carpal tunnel syndrome which involves the median nerve. The treatment is releasing of the flexor retinaculum.

    • This question is part of the following fields:

      • Neurology
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  • Question 29 - Which is the most appropriate agent for the prophylaxis of cluster headaches? ...

    Incorrect

    • Which is the most appropriate agent for the prophylaxis of cluster headaches?

      Your Answer:

      Correct Answer: Verapamil

      Explanation:

      Verapamil, can effectively reduce the number of attacks during a cluster headache period of exacerbation. Oral sumatriptan has not been shown to be effective prophylactically. Verapamil in dosages of 360 to 480 mg daily is one of the few treatments for episodic cluster headache tested in a randomized controlled trial (RCT) and found effective in reducing attack frequency.

    • This question is part of the following fields:

      • Neurology
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  • Question 30 - A 60-year-old male with a history of diabetes and hypertension presented with left...

    Incorrect

    • A 60-year-old male with a history of diabetes and hypertension presented with left sided arm and leg weakness and loss of vision in the left eye for a brief period. His symptoms improved within a few hours. Which of the following is the most appropriate investigation that can be done at this stage?

      Your Answer:

      Correct Answer: Doppler USG

      Explanation:

      Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour. This is the screening test of choice to evaluate for carotid stenosis.

    • This question is part of the following fields:

      • Neurology
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      Seconds

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